So what is gynecomastia and what is the cause? It is the enlargement of the male chest as a result of breast tissue growth. Yes, it is actual breast tissue, not simply fat. All men have some small amount of breast tissue normally. Hormonal imbalances can cause an increase in the level of estrogen (also normally found in men but in much lower levels than women) to rise, signaling breast tissue to enlarge. The hormonal imbalance can occur from prescription medication such as many anti-depressants, psychiatric medications, and weight loss medicines. It can also occur from anabolic steroid use of chronic marijuana smoking. Interestingly enough, when the offending medication or drug is eliminated, the chest may decrease in size but rarely goes away entirely. Obesity triggers the conversion of testosterone to estrogen and can result in male chest enlargement. A more rare cause of male chest reduction is tumors, such as testicular cancer that can secrete abnormal hormones. Enlargement of both sides is most common, although one may become larger than the other. If there is enlargement of only one side, the possibility of male breast cancer must be considered although it is rare.

If you suffer from male chest enlargement, you should be evaluated by a physician. Your physician will perform a history to determine the possible causes. This will include a detailed history of all drug use, both legal and illegal. Also, a physical exam may help determine whether tumors or cancer is a cause. Your physician will also test your blood for hormone levels and possibly have you seen by an endocrinologist. Approximately 80% of the time, there is no detected cause for this and it is termed “idiopathic” – a fancy medical term for “we have no idea why”.

After treating any underlying medical condition or in the case of “idiopathic gynecomastia”, you may be referred to a plastic surgeon for discussion of the options for correction. Gynecomastia reduction surgery is one of the most common procedures among my male patients.

The treatment will revolve around removing the excess tissue. This may be done with liposuction to suction out the breast tissue and fat. Often, there is a hard lump of breast tissue that is felt under the nipple and areola. This is called the “breast bud” and is very resistant to liposuction. The tissue is just too dense to be removed by suctioning alone and needs to be removed through an incision around the areola. In severe cases, there is excess skin as well as underlying breast tissue. In these cases, reduction usually involves removal of breast tissue with a combination of liposuction and excision, as well as removal of the excess skin.

Gynecomastia is extremely common and a major source of embarrassment, no matter what the age. There are many options for correction. You should see a board certified plastic surgeon to learn about these options. To see some of my before and after gynecomastia pictures Click Here.

To learn more, or to schedule your consultation, contact me or call 212-289-1851.

Let’s look at some of the more common procedures:

Rhinoplasty: This is the number one requested procedure among young teens and has become almost a rite-of-passage among high school students in some communities. Young girls usually begin requesting a nose job at 13 or 14 years of age. This is too young for several reasons. Psychologically they are not prepared to make “body image” decisions about themselves, and also physically, the nose is usually still growing. The more appropriate age is 16-17 years old. This is why rhinoplasty is commonly performed on high school students between Junior and Senior year or after graduation.

Liposuction: The surgical removal of fat is a good tool for body shaping and can get rid of those “problem areas”. In this regard, it is never appropriate for young men or women and best reserved for those over 18 years old. In the case of weight reduction, high volume liposuction has recently been shown to be very beneficial in reducing weight and reducing the risk of obesity related illness such as diabetes and high blood pressure. Again, it is best reserved for those over 18 years old, but it may be appropriate for teenagers that meet very strict criteria. If a teenager is obese despite good compliance with diet and exercise, and has shown signs of obesity-related illness, then high volume liposuction may be indicated for medical reasons.

Breast Augmentation: The placement of breast implants is best reserved for women over 18 years old. The one exception is in the case of Poland Syndrome in which one breast fails to develop. Research has shown that the placement of a breast implant on the underdeveloped side to help achieve a more “normal” appearance has significant psychological advantages, even at an age as young as 13 years old.

So, as you can see, while most elective cosmetic surgery is reserved for people over 18 years old, there are some situations where it is appropriate for younger teens. Remember, children under 18 years old need to be accompanied by a parent during the consultation and a parent must give permission for any procedure.

To learn more about the cosmetic surgery procedure you are interested in, or to schedule your consultation, contact us or call 212-289-1851

Let’s look at some examples of implants. A 300cc Low Profile implant is wider and flatter than a 300cc High Profile implant which is narrower and projects more. A Moderate Profile 300cc implant has a width and projection that is in between the other two profiles.

So, what does this mean and how do you know which type of breast implant is best. In general, a person with a narrow torso may be better suited with a High Profile Implant. This is because the other profiles may be too wide for a narrow torso, resulting in implants that are too close in the center (“uni-boob”) or hanging off the side (“side-boob”). However, if a woman has a wide torso, than a wider implant is needed so that the implants help to fill out the chest. In this situation a Low or Moderate profile implant may be better. A High Profile implant will be likely leave too much space in between the breasts.

Your surgeon will play the key role in determining which breast implant profile is best for you. This is done by using specific measurements such as the width of your breast (base diameter), the size of your torso (band width), and the nipple-to-nipple distance. Your surgeon must also factor in your specific desires about implant volume and the desires “look” of your augmentation.

The bottom line is that you should not stress about which implant profile is best. This is a job left to your surgeon. I tell my patients that they should only focus on the volume they desire and then I will recommend a profile type based on multiple factors that were discussed above.

For more information about breast augmentation in New York City, contact Dr. Schulman or call 212-289-1851 to schedule your consultation.

The mother tends to persuade a smaller sized breast implant. Perhaps this is the mother’s maternal instinct to “protect” and she feels that large breast implants will portray an image that is not “daughterly”. I have watched many battles occur in my office between mother and daughter about implant size.

On the contrary, the husband tends to recommend larger implants. This is probably due to man’s attraction to large breasts. Husbands can at times attempt to mold their wives into their ideal image, and if that husband is a “breast-man”, than he will suggest larger implants. It can be quite interesting when I see a woman alone in consultation and we select a small-moderate sized implant, but when she returns with her husband, she is suddenly trying on large sized implants.

Implant size is a matter of personal taste. You need to choose and implant size that you will be happy with. Of course, the person who helps you in the decision process may have a different opinion about which implant size is best, but you need to ultimately make your own decision.

To learn more about breast implant augmentation in New York City with Dr. Schulman, contact me or call 212-289-1851.

This has several advantages. First, it allows women to see the breast augmentation results before they even have surgery. This allows us both to be confident in choosing out implant size. The software is specifically programmed with all the dimensions of every possible breast implant, so that the computer generated “after” pictures are accurate. I can quickly show what a 300cc versus 400cc implant will look like. My particular system also allows me to place 3D virtual clothing on the image so that you can see your “after” in a dress, bikini, or t-shirt.

Also, the software can precisely measure the pre-operative volume of your breasts. This is important in helping my patients see pre-existing asymmetries. It then allows me to determine the appropriate volume of breast implants. If the software measures your right breast as 50cc smaller than the left, we will know to choose and implant for the right that is 50cc bigger than the implant for the left breast.

3D computer imaging is just another tool to help perform breast augmentation more consistently. My patients are more comfortable choosing implant sizes and there is no more second guessing after the surgery.

To learn more about breast augmentation and to schedule your consultation and 3D breast imaging, contact me or call 212-289-1851.

If a breast implant “bottoms out”, it drops below the normal breast fold. This causes the nipple to turn upward and appear near the top of the breast mound instead of over the center. Also, as the breast implant drops lower, the upper pole of the breast becomes flatter.

The cause of this is usually over aggressive dissection of the breast fold. If the surgeon disrupts the support structures of the normal breast fold, the fold weakens and cannot support the weight of the breast implant. Large and heavy breast implants may make this problem more likely.

Repair of this problem involves reconstructing the breast fold. This can be done with carefully placed internal sutures. Recently, surgeons are now using acellular dermis – either human or pig dermis – to help strengthen these internal sutures and to help support the breast implant in the normal position and prevent it from sliding lower. Keep in mind that these materials provide great results and are recommended, but it can add about $2,000 to the cost of your surgery.

“Bottoming Out” is unfortunately common with breast implants and while we have very good and effective ways of repairing it, it is best not to suffer from this at all. Like everything, the key is prevention. Your surgeon must respect the fold. The breast fold is a normal anatomic structure and care must be taken to not damage it during a breast augmentation. I should mention that it is standard to have to slightly lower the fold to accommodate breast implants, but this needs to be done carefully. Also, very large implants in very thin women should be avoided because of this possible complication.

To learn more about Dr. Schulman and his breast augmentation or to schedule your consultation, contact us or call 212-289-1851.

This machine can detect any form of implant in the body, including surgical implants of the hip, wrist and even breast implants. Not to worry though, the security officer who is in front of you, watching over while you are examined will not see the x-ray image. The security officer who views the “x-ray” image of your body is in a remote location. The person examining your “x-ray” will be told when to initiate the process by the security officer in front of you over a hand-held transceiver. The security officer in a remote location will see an image on the screen which only shows outlines of the body and objects in and on the body. Additionally the image comes up fuzzy making facial features unrecognizable.

According to a poll done by CBS News 4 out of 5 Americans are all for the extra security measures and feel safer in the airport as well as in the air, but what percent of those people have undergone plastic surgery. Some people are stating that this is an invasion of privacy. People who want their plastic surgery kept secret feel this outs them. This is completely agreeable, but remember the person that is looking at your x-ray cannot recognize your face. They are looking for weapons and dangerous material that could endanger people’s lives. If they see something odd they will radio to the security officer in front of you and ask them to perform a pad down.

Some people choose to divulge their implant or implants before the scan while others will reveal it at the pat down, or not at all. Whether you inform TSA you have an implant or not, it will not keep you from boarding your flight.

To learn more about the advanced body image scanners, or breast implants contact Dr. Schulman’s office for more details.

In order to understand how problems can be fixed, we must first understand where problems can occur. I like to categorize these problems into 4 major areas:

1. Problem with the implant itself
2. Problem with the size of the implant
3. Problem with the procedure choice
4. Problem with healing

Choosing the implant is of crucial importance and I have written specifically about this in previous blog entries. The shape, texture, and size of implant must be carefully chosen to match your body. Many problems that can occur can be the direct result of choosing an implant that is too big for your body. This can result in implants touching each other in the center (synnmastia), implants appearing to “hang off” the sides, or augmented breasts that now appear “droopy”. Breast implants have a specific width, depending on the size. Your doctor should carefully measure the width of your chest (“base diameter”) so that the proper implant size can be chosen.

Implants must be placed within a carefully created implant pocket. If the implant pocket is too big, then the implant may move around in an unnatural position. If the pocket is not centered under your nipple, then the implant will be positioned too much to the center of your chest or the side. If the pocket is too small, then your implant may be “constricted” and take on an oval shape instead of the natural round shape.

There are also several variations in the type of breast augmentation that is performed. The implants can be placed above or below the muscle. Also, some women come to my office because they want “perkier” breasts and mistakenly think that breast implants will give them a lift. While breast implants do result in a slight lift of the breast tissue, breast augmentation primarily makes the breast larger and will not adequately correct a “drooping” breast. This would require a breast lift, possible with the simultaneous placement of implants. There is complex decision making that must occur, even before you get to the operating room.

Even if your surgeon chooses the right procedure, the correct implant size, and does everything perfectly in the operating room, your body still must heal. Not only must your body heal correctly on the outside (the incision), it must heal correctly on the inside. Abnormal scar formation on the inside may result in capsular contracture – or hardening around the implant. We now know that bacteria and blood can place you at increased risk of this abnormal scar formation, but there are some women who seem to be “predisposed” to capsular contracture. If it can be recognized early, there are some things that we can do to slow the progression.

So, “fixing” the problem relies on the surgeon’s ability to identify what the cause is. Revisional surgery may include exchanging implants to a sixe better suited for your body, enlarging or reducing the implant pocket, removing abnormal scar tissue, or performing a completely different operation than had been done originally (i.e. a breast lift). Some of these complications are avoidable by selecting a surgeon who understands the complexities of breast surgery. However, sometimes problems can occur that are not preventable, but revisional techniques are evolving and surgeons experienced in these complex revisional surgeries can improve things.

Contact us if you have any further questions about fixing bad implants. We will be happy to help!

The internal support of the breast is composed of a network of dense collagen fibers termed “Coopers Ligaments.” This internal bra is responsible for maintaining the shape of the breast, independent of the quality of the overlying skin. As you age, the support structure naturally weakens. The weight of the breast also places strain on the ligaments, thereby “stretching” them over time. This is why it is rare to have naturally large, “perky” breasts. While there is no known way to “strengthen” Coopers Ligaments, wearing a well supporting external bra, especially during exercise, may delay the normal weakening that occurs as you age.

The actual composition of the breast is also important. The breast is composed of a combination of breast tissue and fat. The ratio between the two varies dramatically among women. Women who have heavy, dense breasts may have a breast tissue to breast fat ratio of 2:1. Women with soft, less dense breast have twice as much fat as breast tissue. This ratio between breast tissue and breast fat is very significant in how the breast changes and what breast contouring procedures you may require.

Breasts with a majority of dense breast tissue may be more likely to droop over time. This is because the weight of the breasts causes weakening of the internal support of the breast. As you age, the breast will continue to droop, making a breast lift necessary.

Breast tissue will also change with hormonal changes. So, dense breasts may be more likely to enlarge during pregnancy and breastfeeding. After the hormonal surge of pregnancy is over, the breast tissue may shrink in a process called “post-partum involution”. Correction may require a breast augmentation with implants and sometimes a simultaneous lift.

Breasts with a majority of fat are lighter and less likely to droop. However, the fat in the breast is extremely sensitive to changes in your body weight. Gaining weight may cause your breasts to enlarge and this often does not regress if you are to lose the weight in the future. This may make a breast reduction necessary.

Breast fat is also not as sensitive to the hormonal changes of pregnancy, so enlargement and involution from pregnancy hormonal changes is unlikely. However, weight gain that often accompanies pregnancy may result in enlargement of the breasts. Conversely, weight loss can cause loss of fat in the breast, and make the breast “deflate”. Correction of this may require a breast enlargement with implants.

So, breasts size and shape will changes throughout your life. Understanding the internal support of your breasts, and the ratio of breast tissue to breast fat will help you anticipate these changes. Fortunately, breast contouring has evolved so that there is a procedure for virtually every complaint. New techniques allow for shorter incisions that are more easily hidden, and a more rapid recovery from surgery. Also, implant technology has evolved so that modern implants look and feel more natural, and are more durable then earlier generations of breast implants.

If you are interested in learning more about a breast procedure, contact my office to schedule a consultation.